U.S. patent number 11,013,501 [Application Number 16/210,442] was granted by the patent office on 2021-05-25 for method of protecting the peritoneum against tearing and other injury before an active surgical intervention at or near the peritoneum.
This patent grant is currently assigned to Davol, Inc.. The grantee listed for this patent is Davol, Inc.. Invention is credited to Christopher Bowley, Robert Richard, Devang Vijay Shah.
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United States Patent |
11,013,501 |
Shah , et al. |
May 25, 2021 |
Method of protecting the peritoneum against tearing and other
injury before an active surgical intervention at or near the
peritoneum
Abstract
Methods for protecting a peritoneum or other tissue during a
surgical procedure are disclosed. In some embodiments, a protective
lining is applied to the peritoneum or other tissue before an
active surgical intervention, such as before tissue dissection,
tissue approximation, and/or other surgical act. In some
embodiments, the protective lining includes a protective film
applied to the peritoneum or other tissue via a delivery balloon or
via a spray instrument.
Inventors: |
Shah; Devang Vijay (Franklin,
MA), Richard; Robert (Wakefield, RI), Bowley;
Christopher (Newport, RI) |
Applicant: |
Name |
City |
State |
Country |
Type |
Davol, Inc. |
Warwick |
RI |
US |
|
|
Assignee: |
Davol, Inc. (Warwick,
RI)
|
Family
ID: |
1000005572549 |
Appl.
No.: |
16/210,442 |
Filed: |
December 5, 2018 |
Prior Publication Data
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|
|
Document
Identifier |
Publication Date |
|
US 20190175161 A1 |
Jun 13, 2019 |
|
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
Issue Date |
|
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62596750 |
Dec 8, 2017 |
|
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Current U.S.
Class: |
1/1 |
Current CPC
Class: |
A61B
17/00234 (20130101); A61B 90/04 (20160201); A61F
2/0063 (20130101); A61B 2017/00557 (20130101); A61B
17/0281 (20130101); A61B 2017/00522 (20130101); A61M
2039/0279 (20130101); A61F 2002/0072 (20130101); A61B
2017/00995 (20130101); A61M 39/0247 (20130101); A61B
2017/0225 (20130101); A61B 2090/0427 (20160201); A61B
2017/00951 (20130101) |
Current International
Class: |
A61B
17/00 (20060101); A61F 2/00 (20060101); A61B
90/00 (20160101); A61M 39/02 (20060101); A61B
17/02 (20060101) |
References Cited
[Referenced By]
U.S. Patent Documents
Other References
[No Author Listed] Your Choice of Sealant Matters: Seal to Heal.
DuraSeal.RTM. Dural Sealant System. Integra. Publicly available
before Dec. 8, 2017. 3 pages. cited by applicant.
|
Primary Examiner: Ho; Tan-Uyen T
Assistant Examiner: Igboko; Chima U
Attorney, Agent or Firm: Wolf, Greenfield & Sacks,
P.C.
Parent Case Text
CROSS-REFERENCE TO RELATED APPLICATIONS
This application claims the benefit under 35 U.S.C. .sctn. 119(e)
to U.S. Provisional Application Ser. No. 62/596,750, entitled
"METHOD OF PROTECTING THE PERITONEUM AGAINST TEARING AND OTHER
INJURY BEFORE AN ACTIVE SURGICAL INTERVENTION AT OR NEAR THE
PERITONEUM" and filed on Dec. 8, 2017, the entirety of which is
herein incorporated by reference.
Claims
What is claimed is:
1. A method of applying a protective lining to a peritoneum, the
method comprising: elevating an abdominal wall including a
peritoneum away from viscera to create a working space; performing
an active surgical intervention involving the created working
space, wherein the active surgical intervention is selected from
the group consisting of: a preperitoneal hernia repair, an
intraperitoneal hernia repair, a cholecystectomy, an appendectomy,
splenectomy, and a nephrectomy; and prior to the act of performing
an active surgical intervention, applying a protective lining to at
least a portion of the peritoneum in the working space to
prophylactically prevent shredding, tearing, or other injury to the
peritoneum, protect and/or preserve the fidelity of the peritoneum,
add stability to the peritoneum, and/or facilitate incision
formation and/or closure of the peritoneum, the protective lining
being attachable to the peritoneum and remaining attached to the
peritoneum after the active surgical intervention to minimize or
prevent post-operative adhesion and/or prevent discomfort.
2. The method of claim 1, wherein the act of applying a protective
lining includes applying a pre-formed protective lining to the at
least a portion of the peritoneum.
3. The method of claim 2, wherein the act of applying a pre-formed
protective lining includes providing the pre-formed protective
lining on an expandable delivery device.
4. The method of claim 3, wherein the expandable delivery device
includes an expandable balloon.
5. The method of claim 4, wherein the act of applying the
pre-formed protective lining includes inflating the balloon such
that the pre-formed protective lining contacts the at least a
portion of the peritoneum.
6. The method of claim 4, wherein the step of elevating the
abdominal wall includes elevating the abdominal wall via the
expandable delivery device.
7. The method of claim 2, wherein the pre-formed protective lining
includes a transferable film.
8. The method of claim 7, wherein the transferable film includes an
adhesive to attach the transferable film to the peritoneum.
9. The method of claim 8, wherein the adhesive is moisture
activated.
10. The method of claim 7, wherein the transferable film includes
one or more clips or tacks to attach the transferrable film to the
peritoneum.
11. The method of claim 2, wherein the act of applying a pre-formed
protective lining includes inserting a rolled up pre-formed lining
into the working space via a cannula.
12. The method of claim 11, wherein the act of applying a
pre-formed protective lining includes unrolling the pre-formed
lining via a surgical tool.
13. The method of claim 12, wherein the act of applying a
pre-formed protective lining includes positioning the unrolled
pre-formed lining against the at least a portion of the peritoneum
via the surgical tool.
14. The method of claim 13, wherein the act of applying a
pre-formed protective lining includes attaching the unrolled
pre-formed lining to the peritoneum.
15. The method of claim 1, wherein the act of applying a protective
lining includes spraying a protective lining onto the at least a
portion of the peritoneum.
16. The method of claim 15, wherein the act of spraying a
protective lining includes inserting a nozzle portion of an
instrument for spraying into the created working space.
17. The method of claim 1, wherein the act of applying the
protective lining includes applying a first layer of a protective
lining onto the at least a portion of the peritoneum and then
applying a second layer of a protective lining onto the first
layer.
18. The method of claim 1, wherein the act of applying the
protective lining includes applying a first layer of a protective
lining onto a first region of the at least a portion of the
peritoneum and then applying a second layer of a protective lining
onto a second region of the at least a portion of the
peritoneum.
19. The method of claim 18, further comprising engaging a first
fixation element on the first layer with a second fixation element
on the second layer to close an opening in the peritoneum.
20. The method of claim 19, wherein the first layer is positioned
on a first side of the opening and the second layer is positioned
on a second side, wherein the first and second fixation elements
are engageable to attach the first and second layers to one
another.
21. The method of claim 1, wherein the active surgical intervention
is a laparoscopic procedure or a robotic assisted surgical
procedure.
22. The method of claim 1, wherein the act of applying a protective
lining includes applying the protective lining prior to the act of
elevating the abdominal wall.
23. The method of claim 1, wherein the protective lining is
arranged to resemble native peritoneum tissue.
24. A method of applying a protective lining to a peritoneum, the
method comprising: elevating an abdominal wall including a
peritoneum away from viscera to create a working space; performing
an active surgical intervention involving the created working
space; and prior to the act of performing an active surgical
intervention, applying a protective lining to at least a portion of
the peritoneum in the working space, the protective lining being
attachable to the peritoneum; wherein the act of applying a
protective lining includes applying a pre-formed protective lining
to the at least a portion of the peritoneum, the pre-formed
protective lining including a transferable film having an adhesive
to attach the transferable film to the peritoneum, the adhesive
being moisture activated; wherein the pre-formed protective lining
is arranged to remain attached to the peritoneum after the active
surgical intervention to minimize or prevent post-operative
adhesion and/or prevent discomfort.
25. The method of claim 24, wherein the step of elevating the
abdominal wall includes elevating the abdominal wall via an
expandable balloon.
26. The method of claim 24, wherein the act of applying the
pre-formed protective lining includes applying the protective
lining prior to the act of elevating the abdominal wall.
27. The method of claim 24, wherein the protective lining is
arranged to resemble native peritoneum tissue.
28. The method of claim 24, wherein the active surgical
intervention is a laparoscopic procedure or a robotic assisted
surgical procedure.
29. A method of applying a protective lining to a peritoneum, the
method comprising: elevating an abdominal wall including a
peritoneum away from viscera to create a working space; performing
an active surgical intervention involving the created working
space, wherein the active surgical intervention is selected from
the group consisting of: a preperitoneal hernia repair, an
intraperitoneal hernia repair, a cholecystectomy, an appendectomy,
a splenectomy, and a nephrectomy; and prior to the act of
performing an active surgical intervention, applying a protective
lining to at least a portion of the peritoneum in the working space
via an expandable balloon, the protective lining being attachable
to the peritoneum and remaining attached to the peritoneum after
removal of the expandable balloon and after the active surgical
intervention.
30. The method of claim 29, wherein the act of applying the
protective lining includes applying a pre-formed protective lining
to the at least a portion of the peritoneum.
31. The method of claim 30, wherein the pre-formed protective
lining includes a transferable film.
32. The method of claim 29, wherein the act of applying the
protective lining includes inflating the expandable balloon such
that a pre-formed protective lining contacts the at least a portion
of the peritoneum.
33. The method of claim 29, wherein the step of elevating the
abdominal wall includes elevating the abdominal wall via the
expandable balloon.
34. The method of claim 29, wherein the protective lining is
arranged to resemble native peritoneum tissue.
Description
FIELD
The invention relates to methods of protecting the peritoneum
against tearing and other injury before an active surgical
intervention at or near the peritoneum.
BACKGROUND
The peritoneum is a relatively flimsy lining of the abdominal
cavity that is susceptible to inadvertent tearing and other injury
during a surgical procedure in the abdominal cavity and/or through
the abdominal wall. It is known to apply a film-type barrier to the
peritoneum to prevent formation of post-operative surgical
adhesions, but such film-type barriers are applied only after the
surgical intervention.
SUMMARY
According to one embodiment, a method of applying a protective
lining to a peritoneum is disclosed. The method includes elevating
an abdominal wall including a peritoneum away from viscera to
create a working space, performing an active surgical intervention
involving the created working space, and prior to the act of
performing an active surgical intervention, applying a protective
lining to at least a portion of the peritoneum in the working
space.
It should be appreciated that the foregoing concepts, and
additional concepts discussed below, may be arranged in any
suitable combination, as the present disclosure is not limited in
this respect.
The foregoing and other aspects, embodiments, and features of the
present teachings can be more fully understood from the following
description in conjunction with the accompanying drawings.
BRIEF DESCRIPTION OF DRAWINGS
The accompanying drawings are not intended to be drawn to scale. In
the drawings, each identical or nearly identical component that is
illustrated in various figures is represented by a like numeral.
For purposes of clarity, not every component may be labeled in
every drawing. In the drawings:
FIGS. 1A and 1B illustrate an expandable device for delivering a
protective lining to a peritoneum according to an embodiment of the
present disclosure, with a delivery balloon in a deflated and
inflated configuration, respectively;
FIG. 2 is a view of an instrument for administering a protective
lining to a peritoneum according to another embodiment of the
present disclosure;
FIGS. 3A-3C illustrate a method of applying a protective lining to
a peritoneum according to one embodiment;
FIGS. 4A-4C illustrate a method of applying a protective lining to
a peritoneum according to another embodiment;
FIGS. 5A-5C illustrate a method of applying a protective lining to
a peritoneum according to yet another embodiment;
FIGS. 6A-6C illustrate a method of applying a protective lining to
a peritoneum according to still another embodiment; and
FIG. 7 is a bottom view of a peritoneum with two attached
protective linings.
DETAILED DESCRIPTION OF INVENTION
In various minimally invasive surgical procedures involving the
abdominal cavity, the abdominal wall, including the peritoneum, is
first elevated away from the viscera (e.g., intestine, liver,
stomach) before any active surgical steps are performed. For
example, in a laparoscopic or robotic-assisted repair of an
abdominal wall hernia, an insufflating gas may be introduced into
the abdominal cavity to lift the abdominal wall away from the bowel
and create a working space in which to conduct the surgical
intervention. Once the abdominal wall has been elevated, the
protruding sac may be returned to its proper location and the
weakness in the abdominal wall may be repaired, such as by
placement of a mesh type prosthetic device over, under, and/or
within the abdominal wall defect. Cholecystectomy (gall bladder
removal), appendectomy (appendix removal), splenectomy (spleen
removal), and nephrectomy (kidney removal), are representative of
other conventional minimally invasive procedures that take place in
the abdominal cavity after elevation of the abdominal wall away
from the viscera.
During certain minimally invasive surgical procedures, such as
those addressing an abdominal wall hernia (e.g., inguinal, femoral,
incisional/ventral), active surgical intervention at or through the
peritoneum may be required. End effectors of laparoscopic or
robotic-assisted surgical instruments such as graspers, dissectors,
cauterizers, staplers, and suture appliers, to name but a few, may
be deployed from within the abdominal cavity to work directly on
the peritoneum, and/or to pass through an opening in the peritoneum
to reach the repair site. Such a peritoneal opening may have to be
surgically formed or, if already present, may have to be enlarged
by cutting or otherwise manipulating the peritoneum to allow the
end effectors to reach the hernia in a preperitoneal repair. In
certain minimally invasive procedures of the abdominal cavity,
edges defining an opening of an expanded peritoneum may be grasped
and manipulated to approximate the peritoneum. The peritoneum also
may need to be manipulated to prepare the abdominal wall for
placement of a prosthetic repair mesh such as in an intraperitoneal
repair.
In any of these surgical applications, as well as in other
minimally invasive procedures in the abdominal cavity, the
peritoneum may be susceptible to inadvertent tearing, shredding or
other damage by application of the end effectors of the surgical
instruments. For example, injury to the peritoneum may occur when
incising, manipulating or approximating the peritoneum. As another
example, as surgical instruments are wielded within an expanded
abdominal cavity that is defined by an elevated peritoneum, the end
effectors may inadvertently come into contact with this vulnerable
abdominal wall lining, potentially leading to tearing, shredding or
other damage thereof. As will be appreciated, in such an example,
injury to the peritoneum may occur even during procedures that do
not require manipulating and/or incising of the peritoneum. For
example, surgical instruments may be wielded within and come into
contact with the elevated peritoneum during a laparoscopic or
robotic-assisted cholecystectomy, which ordinarily does not require
manipulation or incision of the peritoneum.
The inventors have recognized that advantages may be realized by
prophylactically providing a protective lining to at least certain
portions of the peritoneum that may be exposed to surgical
instruments before surgical intervention in the abdominal cavity.
The protective lining may be applied to the peritoneum before
elevation of the abdominal wall away from the viscera or may be
applied to the peritoneum after such elevation but before
intervention with laparoscopic or robotically-assisted surgical
instruments that potentially could lead to tearing, shredding or
other harm to the fragile abdominal wall lining. For example, the
protective lining may be applied prior to dissection or
approximation of the peritoneum, or prior to introduction of
surgical instruments through the peritoneum into the preperitoneal
space, or prior to application of surgical instruments in the
intraperitoneal space, as the case may be.
In some embodiments, the protective lining may prophylactically
prevent shredding or other injury to the peritoneum during a
surgical procedure. For example, the protective lining may protect
and/or preserve the fidelity of the peritoneum during dissection
and/or ensure desired approximation of the tissue. The protective
lining also may add stability to the peritoneum and thus aid in
approximating the peritoneum, fixating an approximated peritoneum,
and/or fixating a prosthesis to the peritoneum. Further, the
protective lining may facilitate incision formation through the
peritoneum that does not lead to tearing, shredding or other damage
to portions of the peritoneum neighboring such an incision. The
protective lining also may facilitate closure of the peritoneum.
Additionally, the protective lining may minimize or prevent
post-operative adhesion involving the peritoneum.
In some embodiments, the protective lining is arranged to increase
the strength and/or integrity of the peritoneum. For example, the
protective lining may facilitate approximation of the peritoneum,
incising of the peritoneum, fixation of a repair device to the
peritoneum, as well as atraumatic contact with the end effectors of
one or more surgical instruments.
In some embodiments, the protective lining is permanent while in
other embodiments it may be degradable over time. Thus, the lining
may be arranged to degrade after a desired number of minutes,
hours, days, or months after the surgery. In still other
embodiments, the protective lining may be removed after completion
of the surgical procedure.
In some embodiments, the protective lining is a pre-formed film
that is transferrable to the peritoneum. For example, the
transferrable film may be disposed on a delivery balloon or other
expandable delivery device which, upon expansion, moves the lining
against the peritoneum. The film itself may be tacky or may further
include an adhesive to allow attachment to the peritoneum when the
lining is against the peritoneum. In certain embodiments, fixation
devices such as sutures, tacks, and the like, may be deployed to
unite the film with the peritoneum. In other embodiments, a film is
sprayed directly onto the peritoneum. Preferably, the film is
flexible and movable with the peritoneum so as to cause minimal if
any discomfort post-surgery if the lining remains within the
patient. In some embodiments, the film is arranged to resemble
native peritoneum tissue.
Turning now to the figures, FIGS. 1A and 1B illustrate an example
of a protective lining delivery assembly 100 including an
inflatable balloon 102 and a transferable film 104 disposed on the
balloon 102. As shown, the transferable film may be disposed on an
outer surface of the balloon, although the assembly is not so
limited. In some embodiments, the balloon includes a conduit 106
through which an inflation fluid, such as air, CO.sub.2, saline or
another suitable fluid, is supplied and removed to inflate and
deflate the balloon. Other approaches for expandably deploying a
protective lining are contemplated and should be apparent to one of
skill in the art.
Alternatively, a preformed film may otherwise be provided in the
abdominal cavity and then positioned against the peritoneum. For
example, a rolled up film may be delivered through a cannula into
an expanded abdominal cavity. In such an example, a grasper or
other tool may be used to unroll the film and position the
protective lining against the peritoneum, such as for
attachment.
In some embodiments, the transferrable film 104 includes an
adhesive arranged to attach the film to the peritoneum when the
film is positioned against the peritoneum, such as when the balloon
is inflated. In some embodiments, the adhesive is moisture
activated such that the film is attachable to the peritoneum when
the film makes contact with the tissue. In other embodiments, the
film may be activated, such as photo-activated, to cause the film
to adhere to the peritoneum. The film also may include other
constituents or otherwise be configured to allow the film to join
to the peritoneum. For example, the film may include one or more
clips or tacks to allow the film to join to the peritoneum.
FIG. 2 illustrates another assembly 200 for delivering a protective
lining to the peritoneum. As shown in this figure, the film
delivery assembly 200 includes an instrument having an outlet for
spraying a film on the peritoneum. A portion of the instrument may
include a spray nozzle 208 with one or more openings 212 through
which the film may be delivered. The nozzle may be located in a
distal portion of the instrument or at any other portion that may
be positionable relative to the peritoneum for spray application of
the protective lining. For example, the nozzle may be integrated
into the trocar in some embodiments. Various arrangements for
spraying a protective lining onto a peritoneum are contemplated as
should be apparent to one of skill in the art.
FIGS. 3A-3C illustrate a method of applying a protective lining to
at least a portion of a peritoneum. As shown in these figures, the
abdominal cavity, including the innermost peritoneal lining, has
been elevated away from the viscera, for example by introduction of
an insufflation gas, to create a working space. A cannula 320
extends from outside of the patient through the insufflated
abdominal wall into the abdominal cavity 322. A deflated balloon
302 with a pre-formed, transferrable film is introduced into the
expanded body cavity via the cannula (see arrow X). As shown in
FIG. 3B, the balloon is inflatable via an inflating/deflating means
328 that is coupled to the balloon, such as via a conduit 306. For
example, the inflating/deflating means 328 may supply the inflation
fluid to the balloon via the conduit 306 to inflate the
balloon.
In some embodiments, the balloon 302 is inflated (see arrows Y)
until the film 304 makes contact with the peritoneum 326. The
transferable film may be inherently tacky, include an adhesive, or
otherwise be composed so as to adhere to the peritoneum.
Alternatively, the film may be attached to the peritoneum through
the application of an adhesive between the film and peritoneum, or
by fixation of the film to the peritoneum by suturing, stapling,
and the like.
As shown in FIG. 3C, upon attachment of the film to the peritoneum,
the balloon 302 may be deflated via the inflating/deflating means
328. For example, the previously supplied inflation fluid (e.g.,
CO.sub.2, air, saline or the other fluid) may be withdrawn from the
balloon to deflate the balloon. As shown in this figure, when the
balloon is deflated, the film remains attached to the peritoneum.
The balloon may then be retracted from the cannula 320 (see arrow
Z), leaving the protective film 304 attached to the peritoneum. The
deployed film may then enhance the integrity of the peritoneum and
minimize or even eliminate the occurrence of shredding, tearing, or
puncturing during the surgical procedure.
Although the method described in FIGS. 3A-3C includes first
insufflating the abdominal cavity before inserting and inflating
the film-covered balloon, in other embodiments, the film-covered
balloon may be used to both insufflate the abdominal cavity and
deliver the protective film. For example, as shown in FIG. 4A,
after inserting the cannula 320, a deflated, film-covered balloon
302 may be inserted into the abdominal cavity (see arrow X). As
with other embodiments, as shown in FIG. 4B, the balloon 32 may be
inflated (see arrows Y) via the inflating/deflating means 328. Such
inflation may be used to both elevate the abdominal wall, including
the peritoneum, away from the viscera, and also place the film in
contact with the peritoneum. After inflation, the balloon may be
deflated via the inflation/deflation means, with the film remaining
attached to the peritoneum, and the balloon may be retracted (see
FIG. 4C).
FIGS. 5A-5C illustrate another example by which a pre-formed film
may be applied to the peritoneum. As with other embodiments, the
abdominal wall, including the peritoneum, is elevated away from the
viscera and a cannula 320 extends from outside of the patient,
through the abdominal wall, and into the abdominal cavity 322. As
shown in FIG. 5A, a rolled up film 304 may be delivered to the
abdominal cavity via the cannula 320. Next, a surgical tool 325,
such as a grasper, may be used to unroll the film and position the
film against the peritoneum, such as for attachment. As with other
embodiments, the film may be inherently tacky, include an adhesive,
or otherwise be composed so as to adhere to the peritoneum. Once
the film 304 is attached, the surgical tool may be retracted via
the cannula.
Although only a single pre-formed film is shown as being applied to
the peritoneum via the methods illustrated in FIGS. 3A-3C, 4A-4C,
and 5A-5C, in other embodiments, additional films may be applied to
the peritoneum. In some embodiments, the additional films are
applied on top of the first film attached to the peritoneum. For
example, a second balloon may be inserted into the expanded body
cavity and inflated to attach a second film to the first film on
the peritoneum. In other embodiments, the additional films are
applied to other regions of the peritoneum. For example, a rolled
up film may be introduced into the cannula, with a grasper or other
surgical tool used to unroll the film and position the film against
a second, unprotected portion of the peritoneum for attachment.
FIGS. 6A-6C illustrate another method of applying a protective
lining to the peritoneum. Here, again, the abdominal wall,
including the peritoneum, is elevated away from the viscera such as
by introduction of an insufflation gas. As shown in FIGS. 6A-6B, an
instrument for spraying a protective lining is then introduced
through the cannula 320 (see arrow X) and positioned to apply a
sprayable film over at least a portion of the peritoneum (see
arrows F) desired to be protected. In some embodiments, the film is
applied using pressurized gas supplied via a gas supply 332. In
such embodiments, the pressurized gas acts as a propellant to
distribute the sprayable film, stored in a fluid chamber 334, to
the desired area of the peritoneum (e.g., via a conduit 336
connected to a nozzle 308). Although the sprayable film is shown as
being stored in a fluid chamber connectable to the nozzle, the
sprayable film also may be stored in a reservoir within the
flexible nozzle in other embodiments. As shown in FIG. 6C, after
application of the protective lining to the peritoneum, the
instrument may then be retracted from the body cavity (see arrow
Z).
As will be appreciated, in some embodiments, only a single layer of
sprayable film may be applied to an area of the peritoneum before
removing the flexible nozzle from the body cavity. In other
embodiments, after a first layer of film is applied to the
peritoneum, a second layer of film may be applied to the
peritoneum. As with other embodiments, the second layer of film may
be applied on top of the first layer of film. The second layer of
film also may be applied to a second, different area of the
peritoneum. As will be further appreciated, additional layers, such
as third or fourth layers also may be applied to the
peritoneum.
In some embodiments, application of the film (e.g., either via the
balloon or via the flexible nozzle) may be accomplished with a
surgical instrument that is manipulated by a surgeon. For example,
the surgeon may manually direct the balloon or flexible nozzle
through the cannula and into the body cavity to apply the
protective lining to the peritoneum. In other embodiments,
application of the lining may be accomplished during a
robot-assisted surgery. In such embodiments, a surgeon may direct
one or more mechanical arms with attached surgical instruments. For
example, the surgeon may direct a robotic arm with an inflatable
balloon to pass the balloon into the body cavity (via the cannula),
inflate the balloon to make contact between the lining and the
surrounding tissue, and deflate and retract the balloon from the
body cavity once the lining has been attached the peritoneum.
In some embodiments, the protective film also may be arranged to
facilitate closure of the peritoneum. For example, as shown in FIG.
7, a first protective film 304a attached to the peritoneum 326 may
include a first fixation element 340a engageable with a
corresponding second fixation element 340b on a second protective
film 304b attached to the peritoneum 326. As shown in this view,
the first film and first fixation element are positioned on a first
side of an opening 342 of the peritoneum and the second film and
second fixation element are positioned on a second, opposite side
of the opening. In some embodiments, the fixation elements may be
mechanically engaged with one another. For example, the first
protective film may include hooks that engage with corresponding
loops on the second protective film. Once the fixation elements are
engaged, the first and second films may be attached to one another,
thus closing the opening 342 in the peritoneum. Other arrangements
also may be used to facilitate closure of the peritoneum. For
example, the first and second protective layers may have loops
through which sutures may be passed through to pull the layers
together and close the peritoneum.
Although the apparatuses and methods have been described for
protecting the peritoneum during a surgical procedure, it will be
appreciated that such techniques may be used to prophylactically
prevent shredding or other injury to other tissues in the body that
are exposed during a surgical procedure. Additionally, although
embodiments involving a balloon and a nozzle have been described
for applying the protective film to the tissue, it will be
appreciated that other application methods may be used to apply the
film prior to a surgical procedure.
While the present teachings have been described in conjunction with
various embodiments and examples, it is not intended that the
present teachings be limited to such embodiments or examples. On
the contrary, the present teachings encompass various alternatives,
modifications, and equivalents, as will be appreciated by those of
skill in the art. Accordingly, the foregoing description and
drawings are by way of example only.
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